Provider Demographics
NPI:1376093757
Name:PENN MEDICAL LOGISTICS TRANSPORATION
Entity Type:Organization
Organization Name:PENN MEDICAL LOGISTICS TRANSPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-961-7743
Mailing Address - Street 1:710 N HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-6912
Mailing Address - Country:US
Mailing Address - Phone:717-592-0971
Mailing Address - Fax:717-652-3461
Practice Address - Street 1:2515 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1150
Practice Address - Country:US
Practice Address - Phone:717-961-7743
Practice Address - Fax:717-896-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAA20152466615343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)